International Notes Yaws and Yellow Fever Project --
Ghana
In January 1981, the government of Ghana and 4 major donors
(USAID, WHO, UNICEF, EEC*) began a project to interrupt the
precipitous increase in the prevalence of yaws and to contain the
spread of yellow fever in that country. The project is intended to
support the Ghanaian government's overall goal of providing the
most
effective health care at the most reasonable cost to the greatest
number of people.
By the end of 1981, participants in the project had examined
803,437 Ghanaians (total population about 11 million) for yaws and
had
treated 544,469 of these persons (yaws patients and their
contacts),
each with a single injection of long-acting penicillin. In the
project, 292,037 children were vaccinated against yellow fever,
55,791
against measles, 120,793 against tuberculosis, and 125,715 women of
childbearing age were vaccinated against tetanus. In the areas
surveyed, coverage of the target population with penicillin
treatment
and yellow fever vaccine slightly exceeded the project objective of
80%. The anti-yaws strategy included the use of mobile teams and
the
assurance that fixed health facilities received regular supplies of
penicillin for treating patients and their contacts. However,
mainly
because of shortfalls in gasoline supplies, the mobile teams were
only
able to carry out their field activities on about 43% of the
intended
days of operation.
In the surveyed villages of heavily affected Ashanti, Eastern
and
Central Regions, the prevalence of persons with active yaws was
reduced by the end of 1981 to 53/100,000 population from the 1980
level of 703/100,000.
Reported by Dr EG Beausoleil, Director of Medical Svcs, Dr Yaw
Aboagye-Attah, Deputy Director of Medical Svcs (PH), Dr VK Agadzi,
Chief, Epidemiology Div, FK Kofi, Chief Technical Officer, Ghanaian
Ministry of Health; International Health Program Office, CDC.
Editorial Note
Editorial Note: This timely project demonstrates the feasibility
of
halting the resurgence of yaws in Ghana, where the numbers of cases
of
that disease reported each year increased almost 10-fold between
1969
and 1979 (1,2). Moreover, this was accomplished while persons in
the
same villages were being vaccinated against other important
infectious
agents. In recent years several other countries, particularly in
West
Africa, reported large numbers of cases of yaws and/or endemic,
non-venereal syphilis (1). It is hoped that the impact of this
project and the methods used in it will stimulate other countries
with
similar public health problems to reconsider what might be
accomplished in their own epidemiologic situations. Two of Ghana's
neighbors, Togo and Ivory Coast, have already decided to intensify
their efforts to combat yaws. The emergence of
chloroquine-resistant
malaria, isoniazid-resistant tuberculosis, and now
dapsone-resistant
leprosy (3) illustrate the risks of not acting promptly and
vigorously
to make maximal use of inexpensive, effective, and simple
chemotherapy
against an endemic disease.
CDC. Increase in prevalence of leprosy caused by
dapsone-resistant Mycobacterium leprae. MMWR 1982;30:637-8.
*USAID (United States Agency for International Development), WHO
(World Health Organization), UNICEF (United Nations Children's
Emergency Fund), EEC (European Economic Community).
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